Myasthenia Gravis, MS, Muscle Spasm

Question 0

AChE inhibitors drugs (3)

Answer 0

Neostigmine (Prostigmin)
Pyrodostigmine (Mestinon)
Endrophonium (Tensilon)

Question 1

Myastenia Gravis

Answer 1

Autoimmune disorder
Grave muscle disease fluctuating muscle weakness and fatigue
Ach receptor are blocked

Question 2

What is Myastenic crisis?

Answer 2

Complication that occurs when Myastenia Gravis becomes generalized-> respiration is compromised

Question 3

Which drug is effective for Myastenic crisis?

Answer 3

Neostigmine (prostigmin)

Fast acting AChE inhibitor (20-30min)

Question 4

What is cholinergic crisis?

Answer 4

Exacerbation of MG symptoms due to a overdose of AChE inhibitor.
Occurs usually 30-60 min after taking AChE inhibitor meds, can lead to resp. Arrst
Abnormal pupil constriction (miosis), pallor, sweating, vertigo, excess salivation, n/v, abd cramps, diarrhea, bradycardia and involuntary muscle twitching (fasciculation)

Question 5

Neostigmine (prostigmin)

Answer 5

Short acting AChE inhibitor
Must be given q2-4h ATC on time to prevent muscle weakness.
Effective for MG crisis
Onset 20-30min
Duration 2-4hrs

Question 6

How to differentiate between Myastenia crisis (due to generalized MG) and Cholinergic crisis (due to AChE inhibitor OD)?

Answer 6

Endrophonium (Tensilon) is given IV (only) since it Is a very short acting AChE inhibitor 5-20min duration
If symptoms are relieved –> MG crisis
If muscle weakness is more severe–> Cholinergic crisis

Question 7

Endophonium (tensilon)

Answer 7

Very short acting AChE inhibitor (5-20min duration)

Used to diagnose MG, and to differentiate Myastenic crisis vs. Cholinergic crisis.

Question 8

Side effects of AChE inhibitor

Answer 8

Are the wet ones (opposite to anticholinergic side effects)
N/v, diarrhea, ha, dizziness, abd cramp, excess saliva sweating.
Miosis, blurred vision, bradycardia and hypoTN.

Question 9

Antidote for Cholinergic crisis

Answer 9

Atropine sulfate

Question 10

Patient teaching for pt on AChE inhibitor

Answer 10

Meds ON TIME!
With a small amount of food or milk
45-60 min before meals if no GI distress
Have Atropine sulfate available
Wear a medical bracelet

Question 11

What is the “on-off” effect? And antidote

Answer 11

In pt with MS, when the medications wear off at random and manifested by inability to move, walk and speak.
Antidote is Apmorphine HCL (Apokin)

Question 12

Teaching for pt with MS

Answer 12

• Take meds 1h before and 2hrs after meals
• Iron salt supplement should not be taken within 2hrs before and after meals
• MAOIs must be dcd 12h before the 1st dose
• Warm bath and physical act help with digestion and absorption of the meds.
• May take several month before full therapeutic fx achieved
• Change position slowly, hypoTN
• Caution about on-off effect Apomorphine is the antidote
• Increase sexual and gambling urge